Integrating Dermoscopy for Early Detection and Prevention of Advanced Skin Cancers: Lessons From the End Advanced Skin Cancer Scourge in Albinism Project ( <scp>EASCAP</scp> )

Oculocutaneous albinism (OCA) is a genetic disorder characterized by reduced or absent melanin, predisposing persons with albinism (PWA) to ultraviolet radiation (UV)-induced photodamage and skin cancers [1]. Africa has one of the highest global burdens of OCA, with persistently high UV indices in the region exacerbating the risk of skin cancers [1]. Despite decades of photoprotection and education programs such as those led by Beyond Suncare, Fondation Pierre Fabre and regional albinism foundations, skin cancer remains a major cause of morbidity and premature mortality among African PWA, with up to 98% dying before age 40, primarily from advanced non-melanoma skin cancers (NMSC) [2] (Figure 1). Current skin cancer prevention strategies among African PWA focus mainly on sunscreen distribution, photoprotection education, and provision of protective clothing. However, adherence is poor due to socioeconomic constraints, stigma, discomfort with clothing in tropical climates, and irregular sunscreen access [3]. Poor adherence during childhood and adolescence, driven by peer influence and limited understanding of long-term risks occurs during a critical period during which UV exposure induces mutational changes that predispose to future skin cancers [3, 4]. Studies consistently report high rates of sunburn and actinic keratoses among African PWA, particularly in children and adolescents, emphasizing that UV-induced damage often occurs before sustained protective habits form [4]. The persistently high rate of skin cancers among African PWAs, despite decades of photoprotection efforts, underscores that sun protection education alone cannot address systemic and behavioral barriers. Skin cancer screening among PWAs in many African contexts remains limited, relying mainly on visual inspection, with limited diagnostic accuracy, especially for detecting early NMSC and distinguishing amelanotic and hypopigmented malignant lesions from benign mimics [1]. Dermoscopy, a non-invasive imaging technique that reveals subsurface skin structures, has proven invaluable in distinguishing between benign and malignant lesions, guiding biopsies, and enabling earlier, less invasive management. The End Advanced Skin Cancer Scourge in Albinism Project (EASCAP), supported by the International League of Dermatological Societies, applied a three-pronged strategy: education on sun protection and sun avoidance, total-body dermoscopic screening, and treatment of premalignant and malignant lesions by non-ablative and excisional surgeries, respectively [5]. Participants were consecutively recruited from Nigerian albinism groups and voluntarily underwent total-body skin examination. Among 69 PWA screened, 176 lesions were identified as suspicious, based on dermoscopic features suggestive of malignancy, including polymorphous, arborizing, or glomerular vascular patterns, ulceration, white shiny structures, white circles, pigment-based structures, and atypical structureless areas. Lesions lacking suspicious dermoscopic features were managed conservatively or followed clinically. Histopathology confirmed malignancy in 95.6%, predominantly basal cell (70.5%) and squamous cell carcinomas (24.1%). Many lesions appearing benign on visual inspection were accurately flagged by dermoscopy, illustrating its superior sensitivity over visual inspection for early detection [5] (Figure 2A–D). These findings suggest that dermoscopy, a tool with well-established diagnostic utility in skin cancers, yet underutilized in routine care models for PWA in many African contexts, may be feasibly integrated into skin cancer prevention frameworks for African PWA through training, teledermatology support, and public health policy, which could substantially reduce morbidity and mortality. Moreover, its portability and diagnostic yield indicate potential value as a complement to existing photoprotection initiatives. However, larger studies incorporating implementation research and long-term outcomes are needed before widespread policy adoption can be recommended. This initiative was not designed as a controlled diagnostic accuracy study. Findings should therefore be interpreted as demonstrating feasibility and clinical yield rather than definitive diagnostic performance. In conclusion, effective skin cancer prevention for PWA in Africa must extend beyond photoprotection alone. The EASCAP experience demonstrates that dermoscopy can be successfully incorporated into routine care and can transform albinism care across Africa by enhancing early skin cancer detection. While these findings are encouraging, further multicenter and implementation-focused studies are required to define optimal screening intervals, training models, and cost-effectiveness before broader public health integration. The authors acknowledge the Nigerian Association of Dermatologists and the International League of Dermatological Societies (ILDS) for supporting this project through the DermLink Grant. Appreciation is extended to the leaders of albinism associations in southern Nigeria: Ms. Vivian Ezeonwumelu, Mrs. Nene Bassey, and Ms. Suzzy Nzelu, for their community mobilization and support. The authors also thank the management of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, for providing free surgeries for participants with extensive skin cancers, as well as all persons with albinism who participated in the study and continue to engage in regular dermoscopic skin screenings. The authors express their gratitude to the International Society of Dermatology (ISD) for providing dermoscopy training to Dr. Nkechi Anne Enechukwu through its Mentorship Program in 2019, under the supervision of Professor Lidia Rudnicka. This work was supported by the International League of Dermatological Societies (ILDS) through the DermLink Grant awarded to the Nigerian Association of Dermatologists. The authors declare no conflicts of interest. No financial or personal relationships exist that could have inappropriately influenced the conduct or presentation of this study. The data that support the findings of this study are available from the corresponding author upon reasonable request.